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Background and Aims Brugada Syndrome (BrS), a rare congenital disorder affecting cardiac sodium channels, poses significant risks during anesthesia. Patients are susceptible to sudden cardiac death, ventricular arrhythmias, and may be sensitive to certain anesthetic agents. Close cardiac monitoring is crucial to ensure their safety. Adequate pain control is mandatory, because pain and stress during surgery can increase sympathetic activity which can trigger arrythmias.
Methods A 19-year-old male, ASA ll clinical status, with BrS was proposed for a proximal humerus fracture repair. The patient was proposed for combined anesthesia with standard ASA+BIS monitoring.Defibrillator was prepared in the operating room, and the pads were attached to the patient. The patient underwent interscalene brachial plexus block with a perineural catheter placement, combined with general anesthesia. The ultra-sound guided technique was performed with the patient awake and 10ml of levobupivacaine 0.25% were administered through the catheter, after which general anesthesia was induced with propofol, fentanyl and rocuronium and maintained with sevoflurane.
Results During the perioperative period, the patient was hemodinamically stable with normal sinus rhythm and no ST segment changes. A 0.2% ropivacaine perfusion through the perineural catheter was started postoperatively, for pain control. The patient was discharged 36 hours after surgery without any complications, and a great pain control.
Conclusions The combined anesthesia provided intraoperative hemodynamic stability. Additionally, an opioid-sparing analgesia reduced the postoperative nausea and vomiting risk, thus avoiding the need for drugs that could increase the risk of arrhythmia in this patient. Therefore, this approach is important in patients with Brugada Syndrome, ultimately improving patient outcomes.
Attachment Consentimento Brugada.pdf
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